tbuckley/cabot-search huggingface dataset:
Abstract 9835: Multi-Modality Imaging Assessment of Microbubbles and Cerebral Emboli in Left Ventricular Pulsed Field Ablation
Authors: Laith Alkukhun, Uday Gajjandra Sandhu, Babikir Kheiri, Yan Zhao, Kirby Chiang, Quim Castellvi, Peter Stenzel, randall woltjer, RAMON BARAJAS, Babak Nazer
Journal: Circulation (2022)

Introduction: Pulsed field ablation (PFA) may have a superior safety profile compared to other ablation technologies, but the high-voltage electrical fields have the potential to cause gaseous microbubbles (MB), which may be associated with cerebral emboli. In this study, we evaluate the MB burden of a monopolar, biphasic PFA system (CENTAURI, Galaxy Medical), that delivers a waveform designed to limit MB generation. Methods: After anticoagulation with heparin, healthy and chronic MI swine (30 day survival after 90 minute coronary balloon occlusion) underwent PFA in the LV using an open-irrigated focal catheter under intra-cardiac echocardiography (ICE) guidance and monitoring of MBs. Two additional healthy control swine received 0.5 and 1 ml of air MBs through the lumen of the ablation catheter. Swine underwent brain MRI before and after PFA (or control air MB injection) with T1, T2, FLAIR, ADC and susceptibility- and diffusion-weighted imaging (DWI) interpreted by a neuroradiologist blinded to treatment group. Gross pathology and histology of brains with any MRI findings was performed by a neuropathologist. Results: Four healthy swine underwent 50 PFA applications and 5 chronic MI swine underwent 74 applications. No PFA-related MB formation was noted on ICE. Both control swine developed multiple acute emboli in the left thalamus and caudate on DWI, ADC and FLAIR brain MRI sequences in response to air MB injection (Figure). Of the 9 PFA swine, there were no ADC nor FLAIR sequence abnormalities. There was one instance of a hyperintense focus in the left putamen on the DWI trace image, but absence of ADC or FLAIR affirmation suggested it was artifact. Gross pathology and histopathology of this region did not detect any abnormalities (Figure). Conclusion: Catheter air MB injection caused MR-detectable cerebral emboli in swine. Focal monopolar biphasic PFA with CENTAURI does not generate MBs observable on ICE, and did not cause cerebral emboli in healthy or post-infarct LVs.
Abstract 9829: Exercise-Induced CITED4 Expression is Necessary for Regional Remodeling of Cardiac Microstructural Tissue Helicity
Authors: Robert Eder, Maaike Van Den Boomen, Salva Yurista, Yaiel Rodríguez, Mohammad R Islam, Yin-Ching I Chen, Lena Trager, Jaume Coll-Font, Leo Cheng, Haobo LI, Anthony Rosenzweig, Christiane Wrann, Christopher Nguyen
Journal: Circulation (2022)

Background: Exercise promotes cardioprotective benefits for the adult heart; however, the exercise-induced molecular and microstructural remodeling processes have yet to be fully characterized. This study sought to define the spatial interactions between molecular and microstructural remodeling that are induced by exercise and might result in cardiac protection by evaluating regional correlations of expressed cardiac CITED4, a transcriptional co-regulator previously shown to increase in hearts with exercise, and myocardial architecture mapping with diffusion tensor cardiac MRI (DT-CMR). Methods: In the first cohort, male wild-type C57BL/6J mice were housed with or without free access to a running wheel. In the second cohort, CITED4 cardiomyocyte specific knockout (KO) mice were generated along with control littermates (fl/fl mice) and the methods were repeated. After 8-weeks of voluntary wheel running, the mice were euthanized and their hearts were excised, scanned at 14.1 T MRI, and sectioned. RNA Fluorescent in situ hybridization (RNA-FISH) was used to detect CITED4 and all slides were counterstained with DAPI. All experiments were performed under approval of the IACUC of the Massachusetts General Hospital. Results: The exercised group of cohort 1 showed a significant increase in CITED4 expression and microstructural DT-CMR markers in the lateral wall of the left ventricle (p&lt;0.05 for all). In particular, myofiber orientation, evaluated as helicity (helix angle transmurality), was significantly increased within the exercised group (p&lt;0.05), indicating beneficial changes in the myocardial microstructure. Cohort 2 demonstrated that CITED4 was required for these changes to take place, as the CITED4 knock out exercise group did not replicate the same structural changes seen in cohort 1, while the fl/fl control mice reproduced the expected changes in tissue microstructure following exercise. Conclusion: Exercise induces a regional increase in CITED4 expression that coincides with microstructural remodeling. In addition, we have demonstrated that CITED4 is required for these beneficial exercise-induced microstructural changes to occur.
Abstract 9482: Coronary Spasm in a Patient With Argininosuccinic Aciduria
Authors: Yasuhiro Nagayoshi, Haruka Nagano, Taiki Nishihara, kei morikawa, Masato Nishi, Naritsugu Sakaino, Masafumi Nakayama, Kenichi Tsujita
Journal: Circulation (2022)

Case presentation: A 39-year-old male patient was referred for the treatment of hypertension. The patient had been treated for argininosuccinic aciduria (ASA) since eight months of age. Therapeutic drugs including, L-arginine, sodium phenylbutyrate and antiepileptic drugs had been administered. A detailed medical history taking revealed that the patient sometimes complained of chest discomfort under psychological stress. A 12-lead electrocardiogram showed abnormal q waves in lead III and aVF. Transthoracic echocardiography showed hypokinesis of left ventricular posterior wall. Endothelial function was quantified with brachial artery flow-mediated dilatation (FMD). The patient’s FMD value was 2.4% (normal cut off value 7.0%). Coronary computed tomography angiography showed no significant coronary stenosis. Cardiac magnetic resonance revealed transmural late gadolinium enhancement in the mid-ventricular level of the left ventricular posterior wall. The patient was suspected to have prior myocardial infarction. The patient was started on amlodipine and irbesartan, however, he continued to complain of chest discomfort at rest. Cardiac catheterization was performed to make a definitive diagnosis. The acetylcholine spasm provocation test revealed diffuse left and right coronary vasospasm. Transient ST-segment elevation with chest discomfort was observed. The patient was diagnosed as having coronary spastic angina. Chest discomfort was disappeared after additional administration of isosorbide mononitrate. Discussion: ASA is a genetic disorder of the urea cycle, caused by deficiency of argininosuccinate lyase (ASL). Specific laboratory findings are hyperammonemia, argininosuccinic acidemia and low plasma arginine levels. ASL is required to utilize extracellular arginine for NOS-dependent NO synthesis in endothelial cell. Reduction of ASL enzymatic activity leads to decline in NO production even if arginine is supplemented. Efficacy of NO supplementation for treatment of long-term complications in ASA patients has been reported. The precise mechanisms of coronary spasm remain to be elucidated. Our case report might support the significance of endothelial function in the pathogenesis of coronary spasm.
Abstract 275: The First Series Of Hypothermic Out-of-hospital Cardiac Arrests In A Temperate Urban Area Resuscitated With Prehospital Or Inhospital Extracorporeal Cardiopulmonary Resuscitation: A Fifteen-year Observationnal Study
Authors: Tal Soumagnac, Jean Herle Raphalen, Samraa Yahiaoui, Damien Vimpere, Kim An, Akshay Mungur, Christelle Dagron, Pierre Carli, Alice Hutin, Lionel Lamhaut
Journal: Circulation (2022)

Introduction: Accidental hypothermia designates an unpredicted drop in body temperature below 35°C. The risk of ventricular fibrillation is major below 28°C and cardiac arrest is almost certain below 24°C. In such cases, conventional cardiopulmonary resuscitation is often inefficient. Hypothesis: Hypothermic out-of-hospital cardiac arrest (OHCA) occurs even in temperate urban areas and extracorporeal cardiopulmonary resuscitation (ECPR) has shown good outcomes with this indication. Methods: We conducted a retrospective observational study of patients admitted to a university hospital in Paris, France. We reviewed patients consecutively admitted between January 1, 2008 and April 31, 2022 and treated with prehospital or inhospital ECPR following refractory hypothermic OHCA. The primary outcome was survival at 28 days with good neurological outcomes, defined as Cerebral Performance Category (CPC) 1 or 2. We compared patients according to their cold air or cold water exposure. Results: A total of 38 patients were analysed. Patient characteristics and outcomes are detailed in Table 1. A total of 15 patients (40%) survived at 28 days, 13 (34%) of whom with good neurological outcomes despite a median low-flow of 85 min. No patient survived with good neurological outcomes in the cold-water group. Conclusion: Survival rates with favourable neurological outcomes at 28 days stood at 34% of all patients with hypothermic OHCA who were resuscitated with ECPR. Prehospital ECPR tended to show better survival results (39% vs 30%) but further data are needed to confirm this as the difference was not statistically significant. We found no survivors in the cold-water group raising the question of ECPR indication for these patients in temperate urban areas. In any case, temperature measurement should be systematic in OHCA and there should be predefined care pathways including ECPR for hypothermic OHCA patients even in urban settings with a temperate climate.
Abstract 334: Cardiogenic Shock In Heart Transplant Candidates - Improved Outcome With Impella 5.5
Authors: Miriam Freundt, Robert Devich, Balakrishnan Mahesh, Howard J Eisen, Behzad Soleimani, Robert D Dowling
Journal: Circulation (2022)

Background: Heart transplant (HTX) candidates often develop cardiogenic shock (CS) and require mechanical circulatory support (MCS). UNOS criteria prioritize temporary MCS over durable left ventricular assist devices (LVADs). Extracorporeal membrane oxygenation (ECMO) or intra-aortic balloon pump are associated with poor outcome. In early 2020, we transitioned to using axillary Impella 5.5 in CS patients with both isolated LV or biventricular failure as bridge to HTX. This reports our two-year experience. Methods: We performed a retrospective single center chart review. 19 patients treated with Impella 5.5 as bridge to HTX were identified. UNOS criteria were used to classify CS. If inotropes and diuresis failed to resolve CS, Impella 5.5 was placed via a 10 mm graft sewn to the axillary artery. Key endpoints were survival to transplant without disabling stroke, 30-day and 1-year post-HTX survival. Results: Mean age 55 yrs, 89% male, mean Impella support 19 days (2 - 71, total 369). 58% biventricular failure with at least moderate right ventricular dysfunction (RVD). RVD was managed medically, no RV assist device or ECMO was needed. Transient elevation (&gt;40 mg/dl) of free plasma hemoglobin occurred in 42% but resolved with device repositioning and/or fluids. No renal replacement therapy was required. No serious infectious, vascular or bleeding complication occurred. There was no device malfunction, one pump was replaced due to an exposed wire after 22 days of support. 100% of patients were able to ambulate prior to HTX. Overall survival was 100%. 89% patients were successfully bridged to HTX without major morbidity. Two cases received durable LVAD. One developed non-disabling ischemic stroke on day 16 of Impella support. One elected LVAD as destination therapy after 71 days of support. Stroke free survival during Impella support was 95%. There were no disabling strokes. Post-transplant 30-day survival was 100% (n=17). 1-year post-HTX survival data was 100% (n=10). Conclusion: Impella 5.5 successfully restores hemodynamics in CS in HTX eligible patients with both isolated LV and biventricular failure. RVD in this situation can be managed medically. With this strategy, patients are able to ambulate prior to HTX and survival after HTX exceeds national average.
Abstract 326: Epidemiology Of Pediatric Out-of-hospital Cardiac Arrest In Ontario, Canada
Authors: Janice Tijssen, Marisha McClean, Britney Le, Melody Lam, Teresa To
Journal: Circulation (2022)

Introduction: There are no epidemiological studies of Pediatric Out-of-Hospital Cardiac Arrest (POHCA) in Canada for at least 20 years. Understanding who has a POHCA event is key to prevention, education, and management strategies. Methods: In this retrospective cohort study, we used a validated algorithm applied to large hospital administrative databases to describe the epidemiology of pediatric (age 1 day to &amp;lt 18 years) OHCA in Ontario, Canada, from 2004-2020, by pre-existing comorbidities, sociodemographic features, and outcomes. Results: The cohort included 1,839 unique pediatric patients with a POHCA event with a median age of 2 (0-12) years and 721 patients (39.2%) less than 1 year. Males accounted for 61.1% (n=1,123) of the cohort. Incidence was 4.2/100,000 with a gradual increase over the study period. Thirty percent (n=560) of the cohort lived in a neighborhood in the lowest income quintile, while 13.6% (n=251) lived in a neighborhood in the highest income quintile. Seventy five percent (n=1,380) lived in an urban setting. Seventy nine percent (n=1,444) first presented to a non-teaching, non-pediatric hospital following the POHCA event. The majority (n=1,533, 83.4%) of patients did not have significant comorbidities prior to the POHCA. The most common comorbidity was congenital cardiac malformation for 147 (8.0%) of patients. Three hundred and thirty-three (18.1%) survived hospital admission, and 132 (7.2%) survived to hospital discharge. Less than 6 patients had a subsequent POHCA in the year following the index event. Conclusions: This is the largest Canadian POHCA cohort and the first to describe incidence, comorbidities, and sociodemographic characteristics for this population. This is the first study to use a validated algorithm to create a POHCA cohort using large hospital administrative databases. We found a gradual increase in annual incidence over 17 years, POHCA mostly occurred in healthy children, and survival was lower than other reported cohorts. There were more than double the number of children with POHCA events living in the lowest income quintile neighborhoods compared to the highest income quintile neighborhoods. Most children with POHCA presented to non-teaching, non-pediatric hospitals first.
Abstract 9229: Childhood Opportunity Level Predicts Early and Late Outcomes Following Surgery for Congenital Heart Disease
Authors: Aditya Sengupta, Kimberlee Gauvreau, Emily M Bucholz, Jane W Newburger, Pedro J Del Nido, Meena Nathan
Journal: Circulation (2022)

Introduction: The multifaceted pathways through which a child’s environment impacts outcomes following congenital cardiac surgery remain incompletely characterized. Hypothesis: We hypothesized that childhood opportunity, measured using a US census-track-based, nationally-normed composite metric of contemporary neighborhood opportunity comprising 29 indicators across three domains (education, health or environment, and socioeconomic), would be a predictor of outcomes following congenital heart surgery. Methods: This was a single center, retrospective review of all patients who underwent congenital cardiac surgery from 01/2011-01/2020. Outcomes included pre-discharge (early) mortality, postoperative hospital length-of-stay (PHLOS), inpatient cost, post-discharge (late) mortality, and late unplanned reintervention. The primary predictor was child opportunity level (COL), categorized as very low, low, moderate, high, and very high. Associations were evaluated using multivariable logistic regression, generalized linear, Cox regression, or competing risk models. Results: Of 6133 patients, there were 124 (2.0%) early deaths, median PHLOS was 7 days (IQR 5-13 days), and median cost was $76,000 (IQR $50,000-$130,000). No significant association between COL and early mortality was noted (p=0.21). Children with very low and low COL had significantly longer hospitalizations and incurred higher costs compared to those with very high COL (all p&lt;0.05). At up to 10.5 years of follow-up, very low COL patients had a significantly greater risk of late death (HR 1.7, 95% CI 1.1-2.6, p=0.030) and reintervention (SHR 1.9, 95% CI 1.5-2.3, p&lt;0.001), versus those with very high COL ( Figure 1 ). Conclusions: Child opportunity is independently associated with outcomes following congenital heart surgery. Children from resource-limited settings thus constitute an especially high-risk cohort that warrants closer surveillance and tailored interventions.
Abstract 9733: Echocardiography Workshops Are an Effective Learning Tool for Pre-Clerkship Medical Students
Authors: Ava Gharai, Abigail Cone, Kelsey Wold, David Proszek, Richard Jensen, Charles Anderson
Journal: Circulation (2022)

Introduction: Point of care ultrasound curriculum is being taught in undergraduate medical education (UME) with greater frequency and demonstrable benefit to students’ learning. While echocardiography (echo) curricula have been implemented in a small number of medical schools, there is limited data on the efficacy of the learning experience. Hypothesis: Echo workshops in UME are feasible and effective as a means of introducing medical students to basic echo skills. Methods: 24 pre-clerkship medical students volunteered to undergo 4-hour echo workshops. A variety of preparatory learning materials covering basic aspects of echo were provided to students one week prior to the workshop. A short quiz was administered to all students immediately before and after the workshop. Quiz questions were coded as cardiac anatomy (6 questions), basic echo imaging (8 questions), basic ultrasound and Doppler theory (2 questions), and advanced echo imaging techniques (3 questions). During the workshop, each student was provided at least 30 minutes of hands-on imaging while another student acted as the “patient.” Certified echosonographers and pediatric cardiologists served as the instructors during the workshop. Students completed a survey to characterize the quality of the learning experience. Students’ performance on the quiz pre- and post-workshop were compared using student’s t-test. Results: The mean overall pre- and post-workshop quiz scores were 6.8/19 and 11.4/19, respectively (p&lt;0.00001). Mean pre- vs post-quiz scores for cardiac anatomy were 2.0 vs 3.8/6 (p=0.0001); for basic echo imaging were 3.5 vs 5.3/8 (p&lt;0.001); for basic ultrasound and Doppler theory were 0.5 vs 1.5/2 (p&lt;0.00001); and for advanced echo imaging were 0.7 vs 0.9/3 (p=0.5), respectively. All students characterized the quality of their learning experience through the workshop as a very effective use of their time. Conclusions: Echo workshops targeted to pre-clerkship medical students are feasible, and provide effective learning experiences in cardiac anatomy, basic echo imaging, and basic ultrasound and Doppler theory in the short-term, and are very well-received by students. Providing basic echo curriculum in the pre-clerkship years of medical school should be further explored.
Abstract 9704: Role of Arterial Blood Gas Variables in the Prognostication of Patients With Acute Decompensated Heart Failure Admitted to Cardiac Intensive Care Unit
Authors: Miguel A Quintana, Arnaldo Lopez Ruiz, Marcos Benitez, Jose Gimenez, Jorge Martinez, Johana Roa, Angel Enciso
Journal: Circulation (2022)

Introduction: Several risk factors and scores have been studied to predict in-hospital mortality [IHM] and rehospitalization [RH] in patients with AHF. Hypothesis: The impact of the initial therapies implemented for AHF on the variables of the acid base gases (ABG) has not been evaluated for prognostication of IHM and RH. Methods: We prospectively evaluated 216 patients admitted in CICU with AHF from 2015 to 2021. Demographic, clinical and ABG variables were analyzed on admission and at 24 hours. Patients were grouped according to whether they presented improvement in respiratory failure, defined as improvement in SaO2, PaO2 and PaCO2 as well as de-escalation of respiratory support devices (NIV or high flow). The aim of the study was to identify whether the improvement in ABG variables, O2 requirement or respiratory support within 24 hours of admission is associated with lower IHM and RH at 60 days. Data was analyzed using bivariate and multivariate analyzes by logistic regression. Results: Mean age was 75 years (44% female), normal EF 62% and reduced 38%. Mean NT-pro-BNP was 9280 ng/dl. RH at 60 days was 25% and IHM was 8.7%. Mean PaO2 on admission was 75 mmHg and at 24 hours 82 mmHg, PaCO2 on admission was 38 mmHg and at 24 hours 40 mmHg, mean SaO2 on admission was 94% and at 24 hours 95%. In bivariate analysis, the highest elevation of the PaCO2 on admission as well as PaCO2 at 24 hours were identified as predictors of IHM (38.42 vs 40.26 mmHg, p = 0.025) and (40.17 vs 46.84 mmHg, p = 0.002) respectively. In multivariate analysis, AKI on CKD (p = 0.03), cardiogenic shock (p = &lt;0.0001), acute myocardial infarction (p = &lt;0.004), emergency PCI (p = &lt;0.001), NIV failure (p = &lt;0.001), NT-pro-BNP (p = &lt;0.01), and elevated PaCO2 at 24 hours (p = 0.02) were identified as independent predictors for IHM. No association between the improvement in ABG variables and RH at 60 days was found. Conclusions: The lack of improvement in PaCO2 at 24 hours of admission to CICU for AHF identifies patients at higher risk for IHM. However, there was no association between the improvement ABG variables at 24 hours and the RH for AHF.